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There were a total of 34[2] or 39[3] proposed amendments to the Constitution.

At a Constitutional convention in the middle of 2010, the subject of autonomy for American Samoa was discussed, with the issue being raised by the territory's non-voting member in the United States House of Representatives, Eni Faleomavaega.[4] Resulting from this, the proposed Constitution replaced all mentions of "Government of American Samoa" with "American Samoa Government".[5] Additionally, a paragraph in the preamble to the Constitution was proposed to be changed to reflect that American Samoans should "have and enjoy certain rights ... including the right to local self-government".[6] Furthermore, if the changes were accepted, any federal American law seen as being harmful to the economy of the territory or the welfare of American Samoans could be blocked by the Fono.[7]

The power of the Governor of American Samoa's veto would have changed with the introduction of veto override into the Constitution, whereby a bill passed by a two-thirds majority by both houses of the American Samoa Fono within 14 months of an original veto will become law immediately.[9] As the referendum failed, any vetoed law re-passed by the Fono still requires further approval by the Governor or the United States Secretary of the Interior.[9] A prior referendum on the issue in 2008 failed by 112 votes, after original results showed a mere 22-vote margin.[10]

The new Constitution would have also provided a Samoan language curriculum in the territory's educational system, and introduced a system for post-secondary education to American Samoa.[12] Additionally, it would have established a Public Utilities and Services Commission for the territory, and mandated the enforcement of immigration laws "in order to protect the Samoan culture, lands and way of life".[13]

Despite there being between 30 and 40 different proposed changes to the Constitution which had been approved at the Constitutional convention, all the changes were put to the polls together in a single-question referendum. Voters only had the choice to approve all or reject all the proposals, and could not vote on each one individually,[14] resulting in criticism from voters.[2]

Governor Togiola Tulafono was accused of presenting it as a single question in the poll because he wanted approval for all the changes, a charge he denied. The decision to put all the changes on the ballot as a single question had been made by the chief elections officer,[14] who claimed it was "the simplest way to put the question to voters."[2]

Limited public campaigning took place on the issue of rejecting the constitutional referendum.[15] In Tualauta County in the Western District, the most heavily populated county in American Samoa, there was reportedly concentrated lobbying against the referendum, which was defeated by 609 votes.[15]

The only other public campaigning occurred in Utulei and Tafuna, where a number of residents campaigned against the vote with an advertisement which centered around the decision of the chief elections officer to group all the proposed changes together. The advertisement complained that the amendments "should have been separated, item by item and placed individually on the ballot; they weren't".[15]

The ballot contained the following sole question, printed in both English and Samoan in bold, block letters: "Do you approve the 2010 amendments to the Revised Constitution of American Samoa?" Voters had a choice of voting "yes" or "no".[16]